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Cell Saver for Adult Spinal Deformity Surgery Reduces Cost

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Abstract

Study Design

Retrospective cohort.

Objectives

To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery.

Summary of Background Data

Recent studies have questioned the clinical value of cell saver during spine procedures.

Methods

ASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group).

Results

There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009).

Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient.

Conclusion

Compared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Jeffrey L. Gum MD & Leah Yacat Carreon MD, MSc

  2. Department of Orthopedic Surgery, Institutes of Health, 5th Fl., Washington University School of Medicine, 660 S. Euclid Ave., Saint Louis, MO, 63110, USA

    Michael P. Kelly MD

  3. Baylor Scoliosis Center, 4708 Alliance Blvd, Suite 800, Plano, TX, 75093, USA

    Richard Hostin MD

  4. Center for Clinical Effectiveness, Baylor Scott & White Health, 8080 N. Central Expressway, Ste. 500, Dallas, TX, 75206, USA

    Chessie Robinson MA

  5. Marc A Asher MD Comprehensive Spine Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, 66160, USA

    Douglas C. Burton MD

  6. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th St, Suite R200, Minneapolis, MN, 55454, USA

    David W. Polly MD

  7. Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA, 22908, USA

    Christopher I. Shaffrey MD & Justin S. Smith MD, PhD

  8. Department of Orthopaedic Surgery, New York Spine Institute, 761 Merrick Ave, Westbury, NY, 11590, USA

    Virginie LaFage PhD & Frank J. Schwab MD

  9. Department of Neurosurgery, University of California-San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA

    Christopher P. Ames MD

  10. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Han Jo Kim MD

  11. Presbyterian/St. Luke’s Medical Center & Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO, 80205, USA

    R. Shay Bess MD

Authors
  1. Jeffrey L. Gum MD
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  2. Leah Yacat Carreon MD, MSc
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  3. Michael P. Kelly MD
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  4. Richard Hostin MD
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  5. Chessie Robinson MA
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  6. Douglas C. Burton MD
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  7. David W. Polly MD
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  8. Christopher I. Shaffrey MD
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  9. Virginie LaFage PhD
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  10. Frank J. Schwab MD
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  11. Christopher P. Ames MD
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  12. Han Jo Kim MD
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  13. Justin S. Smith MD, PhD
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  14. R. Shay Bess MD
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Consortia

International Spine Study Group

Corresponding author

Correspondence to Leah Yacat Carreon MD, MSc.

Additional information

Author disclosures

JLG (none); LYC (none); MPK (none); RH (none); Chessie Robinson (none); DCB (none); DWP (none); CIS (none); VL (none); FJS (none); CPA (none); HJK (none); JSS (none); RSB (none).

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Gum, J.L., Carreon, L.Y., Kelly, M.P. et al. Cell Saver for Adult Spinal Deformity Surgery Reduces Cost. Spine Deform 5, 272–276 (2017). https://doi.org/10.1016/j.jspd.2017.01.005

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  • DOI: https://doi.org/10.1016/j.jspd.2017.01.005

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